Research reportHealth literacy and parent attitudes about weight control for children☆
Introduction
Health literacy is the degree to which an individual has the capacity to obtain, understand, communicate, and apply basic health information and services to improve one's health (Centers for Disease Control and Prevention, 2015). About 36% of adults in the USA have inadequate health literacy (Kutner, Greenberg, Jin, & Paulsen, 2006). Health literacy is viewed somewhat differently in medical and public health contexts (Nutbeam, 2000). In medical contexts, low health literacy is viewed as a barrier to healthcare and treatment adherence, requiring that providers and healthcare organizations adapt to become more accessible and user-friendly (Liechty, 2011). In public health contexts, health literacy is viewed as an opportunity for education and empowerment, a capacity-building challenge to enable persons to exercise more agency in their lives and better utilize health information and services (Nutbeam, 2000). Public health literacy also encompasses skills in evaluating public health information and the ability to apply it in ways that impact small groups and entire communities rather than individual health alone (Freedman et al., 2009). To date, most health literacy research has been individually and clinically focused, leaving a gap in our understanding of its family health implications. Improving the health literacy of a parent can affect health behaviors and outcomes for the entire family, and studying early family influences on weight-related health has been identified as a national priority (National Institutes of Health Obesity Research Task Force, 2011). This study examines the impact of parental health literacy on weight-related information-seeking and parental attitudes toward weight control among young children, with implications for both public health and healthcare practice.
Section snippets
Parental health literacy, child health, and child weight
Among adults, low health literacy has been associated with poorer health status and poorer health outcomes such as lower medical adherence, lower awareness of medical condition, longer hospital stays, and greater use of the Emergency Department (Agency for Healthcare Research and Quality, 2011, Nielsen-Bohlman et al, 2004). Low health literacy among parents has also been found to be associated with poor child health outcomes (DeWalt, Dilling, Rosenthal, & Pignone, 2007) and may be a driver of
Information and recommendations on weight loss strategies for children
One of the key components of healthy literacy is the ability to obtain and understand health information, but little is known about where parents look for information regarding child weight loss strategies, or if preferred sources differ by level of parental health literacy. The American Academy of Pediatrics (AAP) issued evidenced-based recommendations for the prevention and treatment of overweight and obesity among children and many of the strategies are directed to parents and the home
Data and participants
Data were drawn from a larger study, STRONG Kids, a prospective, longitudinal panel study that followed preschool age children and primary caregiver (n = 497 pairs) over 3 waves beginning in 2009 (Harrison et al., 2011). The study and sampling design have been described elsewhere (Harrison & Liechty, 2012). We used cross-sectional data from Wave 1 (W1) for this study. The study was approved by the Institutional Review Board of the University of Illinois. Parents in the study were 89.7% female
Results
One in six parents (16%) in this sample had low health literacy. Parents endorsed an average of 4.3 (SD =2.8) weight loss strategies. Overall, 53% endorsed all three recommended weight loss strategies for children, and this rate was higher among parents with adequate (58%) versus low health literacy (24%). In addition, nearly a third (31%) of parents with low health literacy did not mark any of the recommended strategies compared to 11% of their counterparts. Most parents (69%) expressed
Discussion
This study is among the first to describe attitudes toward a variety of specific weight loss strategies among parents of young children, and to our knowledge, the first to find that health literacy is associated with parental attitudes toward specific weight control strategies. Parental health literacy was positively associated with endorsement of recommended weight loss strategies (e.g., increasing fruit and vegetables and physical activity, and decreasing fat intake), and the number of
References (56)
- et al.
Confirmatory factor analysis of the Child Feeding Questionnaire. A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness
Appetite
(2001) - et al.
Academy of nutrition and dietetics benchmarks for nutrition in child care 2011. Are child-care providers across contexts meeting recommendations?
Journal of the Academy of Nutrition and Dietetics
(2013) - et al.
Low parental literacy is associated with worse asthma care measures in children
Ambulatory Pediatrics
(2007) - et al.
Public health literacy defined
American Journal of Preventive Medicine
(2009) - et al.
Misuse of prescription stimulants for weight loss, psychosocial variables, and eating disordered behaviors
Appetite
(2013) - et al.
Attempting to lose weight. Specific practices among U.S. adults
American Journal of Preventive Medicine
(2004) - et al.
What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts
Journal of the American Dietetic Association
(2011) Body image distortion and three types of weight loss behaviors among nonoverweight girls in the United States
Journal of Adolescent Health
(2010)- et al.
MyPyramid.gov. Assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site
Journal of Nutrition Education and Behavior
(2007) - et al.
Dieting and unhealthy weight control behaviors during adolescence. Associations with 10-year changes in body mass index
Journal of Adolescent Health
(2012)
Weight-control practices among U.S. adults, 2001–2002
American Journal of Preventive Medicine
Health literacy interventions and outcomes. An updated systematic review
Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity. Summary report
Pediatrics
Myths, presumptions, and facts about obesity
New England Journal of Medicine
Health Literacy
SAS program for the 2000 CDC growth charts
Tips for parents. Ideas to help children maintain a healthy weight
Strategies and solutions for parents. Overweight & obesity
Social justice and the urban obesity crisis. Implications for social work
Health literacy and child health outcomes. A systematic review of the literature
Pediatrics
Raising issues about children's overweight – maternal and child health nurses experiences
Journal of Advanced Nursing
Evaluating parents and adult caregivers as “agents of change” for treating obese children. Evidence for parent behavior change strategies and research gaps. A scientific statement from the American Heart Association
Circulation
Is dieting good for you? Prevalence, duration and associated weight and behaviour changes for specific weight loss strategies over four years in US adults
International Journal of Obesity
Reducing the digital divide for low-income women with breast cancer. A feasibility study of a population-based intervention
Journal of Health Communication
The national longitudinal study of adolescent health (add health), Waves I & II, 1994–1996; Wave III, 2001–2002; Wave IV, 2007–2009 [machine-readable data file and documentation]
Toward a developmental conceptualization of contributors to overweight and obesity in childhood. The six-C's model
Child Development Perspectives
US preschoolers' media exposure and dietary habits. The primacy of television and the limits of parental mediation
Journal of Children and Media
A systematic review of eHealth interventions to improve health literacy
Health Informatics
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Sources and perceived credibility of child nutrition information in relation to maternal health literacy
2024, Patient Education and CounselingCorrelates of parental feeding practices with pre-schoolers: Parental body image and eating knowledge, attitudes, and behaviours
2016, AppetiteCitation Excerpt :Prospective research will be important in elucidating whether increases in maternal knowledge lead to a reduction in negative feeding practices and therefore reduce the future risk of disordered eating and obesity in children. Such evidence would support recent research whereby higher levels of parental health literacy were related to healthier approaches to children's weight management (Liechty, Saltzman, & Musaad, 2015). Parents of young children have recently reported wanting information on how to implement positive feeding practices in a helpful manner to avoid having a negative impact on their child's relationship with food and their body (Hart, Damiano, Cornell, & Paxton, 2015).
Adolescents’ Nutrition: The Role of Health Literacy, Family and Socio-Demographic Variables
2022, International Journal of Environmental Research and Public HealthValidity and Reliability of the Parental Health Literacy Questionnaire for Caregivers of Children Aged 0 to 3 Years in China
2022, International Journal of Environmental Research and Public HealthNeighborhood Environment and Child Health in Immigrant Families: Using Nationally Representative Individual, Family, and Community Datasets
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Acknowledgements: This research was funded, in part, by grants from the Illinois Council for Agriculture Research to Kristen Harrison (PI), the University of Illinois Health and Wellness Initiative to Barbara Fiese and Sharon Donovan (Co-PIs), and the U.S. Department of Agriculture (Hatch 793-328) to Barbara Fiese (PI). Jaclyn Saltzman was supported by the National Institute for Agriculture under the Illinois Transdisciplinary Obesity Prevention Program (I-TOPP) training grant (2011-67001-30101) to the Division of Nutritional Sciences at the University of Illinois. The authors would like to acknowledge the STRONG Kids Team for data collection and design of the parent study. The STRONG Kids Team includes Kristen Harrison, Kelly Bost, Brent McBride, Sharon Donovan, Diana Grigsby-Toussaint, Juhee Kim, Janet Liechty, Angela Wiley, Margarita Teran-Garcia and Barbara Fiese.
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Listed by name in the Acknowledgments.